Faculty of Medicine, Nutrition Working Group, Universitas Padjadjaran, Bandung, Indonesia.
Department of Human Nutrition, University of Otago, Dunedin, New Zealand.
PLoS One. 2021 Feb 18;16(2):e0247247. doi: 10.1371/journal.pone.0247247. eCollection 2021.
To reduce the burden of early-life linear growth faltering in low- and middle-income countries, interventions have focused on nutrition strategies, sometimes combined with water quality, sanitation, and hygiene (WASH). However, even when combined, their effects on linear growth have been inconsistent. Here, we investigate potential predictors of length-for-age z-scores (LAZ) in a cohort of resource-poor rural Indonesian infants to inform the optimal strategies to reduce linear growth faltering. Apparently healthy rural breastfed Indonesian infants were randomly selected from birth registries at age 6 months (n = 230) and followed up at 9 (n = 202) and 12 (n = 190) months. Using maximum likelihood estimation, we examined longitudinal relationships among socio-demographic status, maternal height, infant sex, age, water source, sanitation facility, energy, protein, micronutrient intakes and biomarkers (serum ferritin, zinc, retinol binding protein (RBP), selenium-adjusted for inflammation), and α-1-acid glycoprotein (AGP) and C-reactive protein (CRP) (systemic inflammation biomarkers) at age 6 and 9 months on LAZ at age 9 and 12 months. Stunting (LAZ <-2) at 6, 9, and 12 months was 15.7%, 19.3%, and 22.6%, respectively. In the full model, the predictor variable at age 6 months that was most strongly associated with infant LAZ at 9 months was maternal height (0.18 (95% CI 0.03, 0.32) SD). At age 9 months, the strongest predictors of LAZ at 12 months were improved drinking water source (-0.40 (95% CI -0.65, -0.14) vs. not improved), elevated AGP compared to not elevated (0.26 (95%CI -0.06, 0.58), maternal height (0.16 (95% CI 0.02, 0.31) SD), sex (0.22 (95% CI -0.02,0.45) female vs. male), serum RBP (0.12 (95% CI -0.01, 0.25) SD), and protein intake (0.17 (95% CI -0.01, 0.35) SD). Health promotion that includes exclusive breastfeeding up to the first six months and follows microbial water quality guidelines to ensure water intake is always safe should be considered.
为了降低中低收入国家儿童早期线性生长迟缓的负担，干预措施侧重于营养策略，有时还结合水质、环境卫生和个人卫生（WASH）。然而，即使结合使用，它们对线性生长的影响也不一致。在这里，我们研究了资源匮乏的印度尼西亚农村婴儿队列中与年龄相关的身高 z 分数（LAZ）的潜在预测因素，以确定减少线性生长迟缓的最佳策略。从出生登记处随机选择 6 个月大的健康农村母乳喂养的印度尼西亚婴儿（n=230），并在 9 个月（n=202）和 12 个月（n=190）时进行随访。使用最大似然估计，我们检查了社会人口统计学状况、母亲身高、婴儿性别、年龄、水源、卫生设施、能量、蛋白质、微量营养素摄入量和生物标志物（血清铁蛋白、锌、视黄醇结合蛋白（RBP）、硒调整炎症）和 α-1-酸性糖蛋白（AGP）和 C-反应蛋白（CRP）（全身炎症生物标志物）在 6 个月和 9 个月时与 9 个月和 12 个月时的 LAZ 之间的纵向关系。6 个月、9 个月和 12 个月时的生长迟缓（LAZ<-2）分别为 15.7%、19.3%和 22.6%。在全模型中，与 9 个月时婴儿 LAZ 最密切相关的 6 个月时的预测变量是母亲身高（0.18（95%CI 0.03，0.32）SD）。在 9 个月时，12 个月时 LAZ 的最强预测因素是改善饮用水源（-0.40（95%CI-0.65，-0.14）与未改善），与未升高相比，AGP 升高（0.26（95%CI-0.06，0.58），母亲身高（0.16（95%CI0.02，0.31）SD），性别（0.22（95%CI-0.02，0.45）女性与男性），血清 RBP（0.12（95%CI-0.01，0.25）SD）和蛋白质摄入量（0.17（95%CI-0.01，0.35）SD）。应考虑促进健康，包括在头六个月内进行纯母乳喂养，并遵循微生物水质准则，以确保饮用水始终安全。
